Category: Medicine
Kilkenomics
As Martin Lousteau, Argentina’s youngest-ever finance minister, told one audience: “It’s a very bad thing when economists start to be interesting.”
That was said at the recent Irish four-day comedy and economics festival, namely Kilkenomics. Here are other reports from the festival. One bit:
"Ireland needs a new credit rating agency. Moody & Poor," says Colm O'Regan, an IT consultant turned comedian.
And:
The economics festival features more than 20 events, with sessions including “The Best Way to Rob a Bank is to Own It,” and “What the Hell Just Happened.”
Here are some YouTube videos from the festival; I have not culled through them.
Unsung development miracles?
Dani Rodrik writes:
Which are the countries that have improved their human development indicators the most since 1970 relative to their peers? You’d be surprised, as I was, to find that the top 10 is dominated not by East Asian superstars, but by Moslem countries: Oman, Indonesia, Saudi Arabia, Tunisia, Morocco, and Algeria. This year’s Human Development Report is full of neat analysis and results, including this one.
Leaving aside the oil exporting countries, the North African cases are particularly interesting. As Francisco Rodriguez and Emma Samman, two of the report’s authors, note, Tunisia, Morocco, and Algeria have experienced remarkable gains in life expectancy and educational attainment, leaving many Asian superstars in the dust. Only Tunisia among the three is a high growth country, underlining one of the report’s main findings that economic growth and human development often diverge significantly, even over as long a time frame as 40 years.
Haiti update: life on the Malthusian frontier
Several of them said, yes, they drank water from a river known to be contaminated with the cholera-causing bacteria. And, no, they don’t always have money to buy bottled water.
“We know there may be cholera in there, but sometimes it is all we have to drink,” said Alienne Cilencrieux, 24. “If we have Clorox, we pour some in and drink it. It tastes bad. Or we dig in the ground until we find water and drink that.”
Here is more.
Yuck markets in everything
There is a market in baby foreskins:
Because of this, they’re not tossed out with the rest of the medical waste after a birth. Instead, hospitals sell them to companies and institutions for a wide variety of uses. Companies will pay thousands of dollars for a single foreskin.
Some of the strangest purposes they’re put to:
- Cosmetics: Foreskins are used to make high-end skin creams. The skin products contain fibroblasts grown on the foreskin and harvested from it. One foreskin can be used for decades to produce fancy face cream like the SkinMedica products hawked on Oprah.
- Skin grafts: In addition to making products for skin, a baby’s foreskin can be turned into a skin graft for a burn victim. Because the cells are extremely flexible, they’re less likely to be rejected. Currently, this technology can be lifesaving in providing a real skin “band aid” to cover an open wound while a burn victim heals. Researchers at Harvard and Tufts are working on advanced skin replacements that use human foreskins.
- Cosmetic testing: All those cruelty-free cosmetics you buy? Some of them are tested on foreskins. This yields better results, since they’re human skin. And it saves the lives of the rodents your shampoo would otherwise be tested on.
Does this make the hospital ever-so-slightly more interested in continuing the practice? For the pointer I thank Andromeda.
Britain fact of the day
In 1960, the British drank 3.6 pints of wine per head per year; by 1971 they drank 7 pints, by 1973 9 pints, by 1975 11 pints and by 1980 almost 20 pints. One obvious reason was that it was cheaper than ever, with the duty having been slashed when Britain joined the EEC; another was that people picked up the taste on holiday; a third was that wines were advertised more successfully, being associated with glamour, luxury, and ambition, and aimed particularly at young women.
That is from Dominic Sandbrook's excellent State of Emergency, The Way We Were: Britain, 1970-1974.
Portuguese drug decriminalization
Caitlin Elizabeth Hughes and Alex Stevens have written a new study:
The issue of decriminalizing illicit drugs is hotly debated, but is rarely subject to evidence-based analysis. This paper examines the case of Portugal, a nation that decriminalized the use and possession of all illicit drugs on 1 July 2001. Drawing upon independent evaluations and interviews conducted with 13 key stakeholders in 2007 and 2009, it critically analyses the criminal justice and health impacts against trends from neighbouring Spain and Italy. It concludes that contrary to predictions, the Portuguese decriminalization did not lead to major increases in drug use. Indeed, evidence indicates reductions in problematic use, drug-related harms and criminal justice overcrowding. The article discusses these developments in the context of drug law debates and criminological discussions on late modern governance.
Sentences to ponder
In four years' time, the minimum cost of labor will be a $7.25 cash minimum wage and a $5.89 health minimum wage (family), for a total of $13.14 an hour or about $27,331 a year.
That's John Goodman, via Arnold Kling.
CA Organ Donor Law
California has a new law creating a live donor registry for kidney transplants and requiring California drivers to say yay or nay on whether they want to be organ donors when they renew their drivers' licenses. The law was passed with the prodding of Steve Jobs who last year had a liver transplant.
The live donor registry is very good. The required declaration is mixed but I hope it works. I see it as follows. The benefit is that if a potential donor has said yes to organ donation then next of kin almost always agree to their wishes so if more people positively affirm that is good. The cost, however, is that now "no" really means "no" and next of kin will presumably agree to that as well. Previously, next of kin might have said yes to non-signatories. Let's use some back of the envelope figures:
100 potential donors
20 signed organ donor cards
80 do not sign but, among these, half the families say yes so 40.
Total: 60 donors.
So with declaration you need more than 60 to agree to be organ donors, i.e. a huge increase in those saying yes. It could happen if what people say on surveys about supporting organ donation is true but I would have been much happier with even a small incentive to sign. How about a free iPhone for signatories? Or at least some more minutes!
See here for more on incentives and organ donation.
Addendum: Nudge blog has some helpful comment–the law appears to be closer to mandated ask than mandated choice.
Why is hospital food so nutritionally bad?
Mario Rizzo asks me:
Why is hospital cafeteria food so poor from a nutritional point of view? Fried chicken, preservative-filled cold cuts, cheese everywhere, etc. Keep in mind I am not talking about the food served patients who may have appetite problems. It is food they serve everyone else including doctors and nurses, many of whom know better.
You'll find some proximate answers here, referring to the institutional arrangements for supplying the food. Here is a UK discussion. Here are some signs of progress. I would make a few more fundamental points:
1. Few people choose a hospital on the basis of the food or on the basis of the food their visitors can enjoy. Furthermore the median American has bad taste in food and the elderly are less likely to enjoy ethnic food or trendy food. You can't serve sushi. They are likely to use the same food service contract for the patients and the visitors.
2. For the patients, some of the food is designed for the rapid injection of protein and carbohydrates. For a terminally ill patient who is losing weight and wasting away, this may have some benefits. Since healthier people tend to have very brief hospital stays, they can undo the effects of the fried chicken once they get out. Many of the sicker patients in for longer stays have trouble tasting food properly at all.
3. Taxing hospital visitors is one way of capturing back some of the rents reaped by patients on third-party payment schemes.
4. I would be interested to know more about the insurance reimbursement rates for hospital food, but at the very least I suspect there is no higher reimbursement allowed for higher quality. Combine third party payment with a flat price for rising quality and see what you get. Furthermore, low quality food is another way the hospital raises its prices to inelastic demanders, again circumventing relatively sticky reimbursement rates from the third party financiers. It's one sign that the net pressures are still in inflationary directions.
5. You can take the quality of the food as one indicator of the quality of other, harder-to-evaluate processes in the hospital.
One reason why fiscal reform is difficult
Joblessness and the accompanying loss of health benefits drove an additional 3.7 million people into the Medicaid program last year, the largest single-year increase since the early days of the government insurance plan, according to an annual survey by the Kaiser Family Foundation.
Enrollment in the program, which provides comprehensive coverage to the low-income uninsured, grew by 8.2 percent from December 2008 to December 2009, the second-largest rate of increase in the 10 years that Kaiser has conducted the survey. There were 48.5 million people on Medicaid at the end of 2009, or about one of every six Americans.
The article is here. The dilemma is simple: variations in Medicaid coverage account for a lot of the variation in the health of state government finances. Yet if states cut back on Medicaid in some manner, there will be more people on the more expensive subsidized exchanges, come the full onset of the Obama health plan.
Guess who is lobbying against marijuana legalization?
Yup, beer distributors and the police. Ryan Grim of The Huffington Post does a very nice job on the politics:
The California Beer & Beverage Distributors is spending money in the
state to oppose a marijuana legalization proposition on the ballot in November,
according to records filed with the California Secretary of State. The beer sellers are the first
competitors of marijuana to officially enter the debate; backers of the
initiative are closely watching liquor and wine dealers and the pharmaceutical
industry to see if they enter the debate in the remaining weeks…
Public Safety First is largely funded by a different industry whose interests are threatened by the legalization of marijuana: law enforcement. Police forces are entitled to keep property seized as part of drug raids and the revenue stream that comes from waging the drug war has become a significant source of support for local law enforcement. Federal and state funding of the drug war is also a significant supplement to local forces' budgets.
Amusingly, the Teamsters and the teachers (!) are supporting legalization:
The Service Employees International Union, a major presence in California, has endorsed the proposition. The Teamsters in September made its first successful foray into organizing pot growers. The United Food and Commercial Workers is backing the initiative and organizing cannabis club employees in the Bay Area. The teachers union, citing the revenue that could be raised for the state, is also backing the initiative.
Very bad incentives in New York State
State institutions for the developmentally disabled generate so much federal Medicaid money that New York's other programs for people with intellectual disabilities would be threatened without them, state officials acknowledge in an internal document obtained by the Poughkeepsie Journal.
The article is here. It gets worse:
The document, labeled "Confidential – Policy Advice," raises questions about the state's decision to keep 1,100 institutional beds at eight centers that were once slated to close.
And that is not all:
The Medicaid reimbursement rate for state institutions is $4,556 per person per day, the Poughkeepsie Journal has reported, three to four times higher than the cost of care.
Or this:
Put another way, just 1 percent of New York's developmentally disabled population – its 1,400 institutionalized people – generates about 40 percent of federal Medicaid money for the system, operated by the state Office for People With Developmental Disabilities.
This is one root of the problem:
The reason New York's rate is so much higher than the cost of care is a provision in the formula that, since the 1980s, allowed the state to keep two-thirds of federal payments for residents moved from institutions into community homes.
The Poughkeepsie Journal uncovered quite a story. How does this sentence grab you?:
New York is well-known among disability researchers and providers for its ability to maximize Medicaid revenues, reaping more federal money for the developmentally disabled than any other state.
And does it put people to work?
New York's nine high-cost institutions are part of the reason, but a greater factor is the sheer size of the system, which serves 125,000 people including nearly 37,000 in 7,500 state and private group homes. The state even has a $27-million-a-year research center on developmental disabilities, and a huge bureaucracy to manage all that: 27,000 employees in 2009 earning an average of $42,000. This includes 278 people who made more than $100,000, according to an analysis of the state's salary database.
If we pursue an earlier story, and ask about the people living in the system, it gets truly scary:
Opened in 2001 without public input or review, the LIT [Local Intensive Treatment Unit, part of this system] serves what officials say are people who have had a brush with the law. Residents are classified by "offending behaviors," and, unlike those in two other units of what is now called the Wassaic campus of the Taconic Developmental Disabilities Service Office, they are not free to leave.
The Wassaic LIT and 10 other "intensive treatment" units – some with uncomfortable resemblance to prisons – mark a stark departure from the state's historically non-punitive approach to care of people with mental disabilities.
…In fact, numbers the state did provide show the LIT is populated mostly by people who have been transferred not from the criminal justice system but from other units here and across the state system.
To return to one of the original facts:
Every one of the unit's residents, among 1,400 residents in nine state institutions, generates $4,556 per day in state and federal Medicaid reimbursements.
Twelve percent of the residents are listed as being institutionalized for "elopement." This guy offered an skeptical perspective on what is happening:
"I don't believe that that is the case, that these people are offenders," said Sidney Hirschfeld, director of the statewide Legal Service office.
He said a very small number had any involvement in the criminal justice system and was concerned that residents were being classified by offenses for which they were not charged, tried or convicted.
Need I relate stories such as this?
In one case, a mildly disabled woman in her 50s was kept in a unit so long – 15 years – that she developed aggressive "institutional behaviors" that became the justification to keep her there. A judge ordered her released, Shea said, but months later a community home still has not been found.
“Those situations are not unique,” Shea said. “Lengths of stay are 10 to 12 years.”
And here is another perspective, from inside the politics:
“Whatever they do there, my preference would be to obviously save jobs,” Euvrard said
For the pointer I thank the ever-vigilant Michelle Dawson.
The rule of law, or the rule of men (women)?
The Obama administration on Thursday told health insurers that it will track those who enact "unjustified" rate increases linked to the health overhaul and may block those companies from a new marketplace for insurance coverage.
Kathleen Sebelius, secretary of Health and Human Services, issued the warning in a letter to Karen Ignagni, the insurance industry's top lobbyist.
Ms. Sebelius said some insurers were notifying enrollees that their insurance premiums will increase next year as a result of the law's new benefits.
…"There will be zero tolerance for this type of misinformation and unjustified rate increases," Ms. Sebelius wrote. "We will not stand idly by as insurers blame their premium hikes and increased profits on the requirement that they provide consumers with basic protections."
Nowhere is it stated that these rate hikes are against the law (even if you think they should be), nor can this "misinformation" be against the law. Here is further information, including a copy of the letter, which is worse than I had been expecting.
Pakistan fact of the day
To put matters in their depressing context, the number of children who perish daily from water-related diseases is several times higher than the rate at which people perished in last week's devastating floods.
There is more here. The article, which is interesting throughout, focuses on the multiple problems in Pakistani water policy.
I suppose this is good news, sort of
A court in Tanzania has sentenced a Kenyan accused of trying to sell an albino to 17 years in jail and a fine of more than $50,000 (£41,200).
Albino body parts are valued highly in parts of East Africa and many albinos have been enslaved and/or murdered as a result. It is believed that since 2007 there have been 53 albino killings in Tanzania. The full story is here and I thank Ashok Hariharan for the pointer.
File under "Thwarted Markets in Everything."